Consolidated Strategic Plan for AGH-CPDMH Us/SP2017_forweb.pdf · As such, AGH and CPDMH along with...
Transcript of Consolidated Strategic Plan for AGH-CPDMH Us/SP2017_forweb.pdf · As such, AGH and CPDMH along with...
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Consolidated Strategic Plan for AGH-CPDMH May 25, 2017
Table of Contents
Page
1. Background 2
2. How The Plan Was Developed 3
3. Context for The New Plan 4-5
4. Highlights of Demographic/Utilization Review 6-10
5. Stakeholder Feedback 11-12
6. The Collective Vision for the Alliance 12-13
7. Key Strategic Directions for Both Hospitals 13-16
8. Separate Strategies and Priorities for Each Hospital 17-18
9. Next Steps 18
Appendices 19-25
Almonte General Hospital
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1. Background
In March 2016, the Boards of Directors of Almonte General Hospital (AGH) and Carleton Place & District
Memorial Hospital (CPDMH) (collectively “the Alliance Hospitals”) signed a legally binding agreement to
form the Mississippi River Health Alliance (MRHA) to achieve the following as independent
corporations:
(i) Provide coordinated oversight of a shared CEO and the performance management
system/process related to the CEO position, and
(ii) Together with the shared CEO, proactively identify, explore and recommend strategic and
system integration opportunities to the AGH and CPDMH Boards, and
(iii) Provide oversight to the relationships established by the alliance
The Champlain LHIN Board of Directors issued a facilitated integration order in support of the MRHA on
April 27, 2016.
As part of their commitment to proactively planning for the future, both hospital boards agreed to build
on their respective 2012-17 and 2013-17 strategic plans to create a roadmap for the growth and
development of the organizations in the coming years. In order to facilitate the development of this
roadmap, both boards agreed to a coordinated process to ensure alignment of their strategic planning
processes, strategies, goals, priorities and timelines. In August 2016, the hospitals issued a Request for
Proposals (RFP) with the following deliverables:
1. For AGH - a Strategic Plan which has clearly articulated goals each with specific metrics corresponding to expected outcomes. High-level implementation plans will be defined as the final component of the Plan.
2. For CPDMH – a Strategic Plan which has clearly articulated goals each with specific metrics corresponding to expected outcomes. High-level implementation plans will be defined as the final component of the Plan.
3. For the MRHA – a roadmap to the achievement of aligned strategic planning cycles, a common strategic framework and common criteria to help the Boards and CEO set implementation priorities for strategic goals and objectives.
In October 2016, the contract for strategic planning services was awarded to tng leaders.
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2.How The Plan Was Developed
The following process steps were used to create a consolidated plan for both hospitals:
The Environmental Scanning and Stakeholder Consultation processes are described in sections 3, 4 and 5
of this report. The results of this extensive data collection process were brought forward to strategic
planning retreats held in early April 2017.
The April board retreats were scheduled as follows:
Friday, April 7th – Joint Meeting of both Boards to Review Background Materials
Saturday, April 8th – Separate Meeting of CPDMH Board & Senior Management Team
Sunday, April 9th – Separate Meeting of AGH Board & Senior Management Team
A summary SWOT analysis from each hospital’s board retreat is contained in Appendix A1 and A2.
Based on the two hospital retreats, two high-level strategic direction documents were developed for
review by the Mississippi River Health Alliance Committee. At the Committee’s May2, 2017 meeting,
there was consensus that a single consolidated strategic plan should be prepared for both Boards that
highlights both the shared strategic directions and unique contributions and unique directions of each
hospital. The rationale for a single consolidated plan is:
Many shared strategic goals between the two hospitals
Top priority for both hospitals is a single, shared clinical services plan that builds on the
strengths and assets of both sites
Strong internal and external support for the Alliance to pursue further collaborative
opportunities
Environmental Scan
(Dec. 2016 - Jan 2017)
Stakeholder Consultations
(Feb. 2017)
Board and Senior Team
Retreats
(April 7-9, 2017)
Alliance Committee Review of Strategic
Directions
(May 2, 2017)
Consolidated Strategic Plan
(May to September
2017)
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3. Context for The New Plan
External Environment
The Alliance Hospitals exist in a health system that has national, provincial, regional and local imperatives and influences. Some of these have direct relevance for the development of a vision for the preferred future of the MRHA partners.
The following are some key ‘take-aways’ from the environmental scan:
The federal government’s focus during the most recent funding negotiations with the provinces
has been on home care and mental health services. The new federal health agreement reduces
the Canada Health Transfer from 6% to 3% and offers new funding for the two priority areas.
The provincial government’s health transformation agenda has been unfolding over 10 + years
and an ongoing priority has been to reduce dependence on hospital-based care through greater
investments in primary care, home care and community care.
Provincial health strategy is consistent with a growing body of international research on high-
performing health systems1.
Performance measurement in hospitals has traditionally focused on financial and utilization
performance, and more recently on quality improvement indicators but the Ministry and the
LHINs are increasingly interested in health system performance as measured by ‘The Triple Aim’
(“the best care, for the whole population, at the lowest cost”).
The passage of Bill 41 (‘Patients First’) represents the first major structural changes in Ontario’s
health care system in a decade – specifically the dissolution of CCACs and the expanded
responsibilities of the LHINs. These changes will lead to debate about the organization, funding
and delivery of future home care services.
Health system funding reform continues to evolve with the refinement of funding
methodologies and the introduction of bundled (integrated) payment models. The Ministry is
developing new small hospital funding models and is planning to consult with hospital
stakeholders later this year.
Lanark County is bisected by the Champlain and South East LHINs, with county-based health
services such as Lanark County Mental Health generally falling within the purview of the South
East LHIN. As such, AGH and CPDMH along with the Champlain LHIN have less influence over
the quality and quantity of service provided to residents of the catchment area.
1 Baker, Ross and Dr. Renata Axler, “Creating a High Performing Health Care System for Ontario: Evidence
Supporting Strategic Changes in Ontario”, (University of Toronto), October 2015
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The Champlain LHIN is supporting two rural health hub pilot projects (Arnprior and Barry’s Bay)
in addition to the five provincial pilot sites.
The Champlain LHIN does not have a comprehensive clinical services plans nor a strategy for
small hospitals but instead has chosen to develop regional plans for specific services; more
recent LHIN plans that are likely to impact AGH and CPDMH are:
o Orthopedics
o Sub-Acute Care
o Home Care
o Inpatient Mental Health
o Child and Youth Services
There is uncertainty about the new LHIN sub-regions in terms of functions, roles and accountabilities and it is unclear how the new sub-regions will impact the LHIN’s funding priorities and overall strategic plan. Almonte and Carleton Place are part of the Western Champlain sub-region which consists of all of Renfrew County plus North Lanark and Kemptville.
Other important contextual issues potentially impacting our collective future and the communities we
serve are:
Funding of small hospitals has not kept pace with operating expenses
The lack of multi-year hospital funding creates challenges for planning future staffing and services
Provincial election – to be scheduled on or before June 7, 2018
Municipal elections – scheduled for October 22, 2018
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4.Highlights of Demographic/Utilization Review
A Demographic/Utilization review document was prepared by the tng consulting team (based on data
prepared by Healthcor Inc.).
The following are some key ‘take-aways’ from the review of demographic, health status and utilization
data:
The combined catchment area of the Alliance includes a number of West Ottawa census tracts
(see map below) totaling 21,922 residents according to the 2016 Census; an increase of 5.7%
since 2011.
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0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
2006 2011 2016
Chart 1 - Municipal Population Growth in Lanark County , 2006 - 2016
Mississippi Mills Carleton Place Smiths Falls
Drummond & NE Beckwith Perth
Within Lanark County, North Lanark including Carleton Place and Mississippi Mills are continuing
to experience stronger population growth than the rest of Lanark County (see Chart )
Stronger population growth rates are expected to continue in Carleton Place and Mississippi
Mills and in the larger Alliance catchment area including the portions of West Ottawa
South Lanark communities are stagnant or declining in population and, as a result, are aging
more quickly than North Lanark
Current population forecasts used by LHINs are developed by the Ministry of Finance and do not
account for local municipal planning indicators such as building permits and housing starts. As a
result, in faster growing areas, provincial forecasts tend to underestimate local population
growth
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Repatriation Opportunities
To grow existing services:
Inpatient Obstetrics and OB/Gyn procedures
General Surgery
Urology
Orthopedic Surgery
To create new SDS services for:
Gastroenterology
Ophthalmology
20,184
18,135 18,071 19,051
18,013
14,833 14,840 14,727 15,105 15,483
2011-12 2012-13 2013-14 2014-15 2015-16
Chart 2 - Emergency Visits, 2011 - 2016
CPDMH AGH
Annual emergency (ER) visits have increased slightly at AGH but have been declining over time
at the CPDMH site despite local population growth (see Chart 2). It is difficult to know how
much of this decline is attributable to the aging ER physical plant at CPDMH which has been
approved by the Ministry of Health and Long Term Care for upgrade.
Compared to other small hospitals, both sites have a higher proportion of CTAS 1-3 (i.e. higher
acuity) ER visits
Unlike the patient origin profile for ER visits and
inpatients, Carleton Place and Mississippi Mills make
up a relatively small proportion of the same day
surgery (SDS) volumes.
Using the combined MHRA catchment area, there
are a number of repatriation opportunities based on
outflow of cases to Ottawa facilities:
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35 31 29 28 27
10
Chart 4 - Inpatient Rehab Cases per 10,000
The projection of future bed requirements based on Ministry of Finance population projections
suggests no additional acute beds are needed if there are improvements in utilization (i.e. ALC
rates of 15%, occupancy rates of 70%, gradual length of stay improvements over time). This
assumes no change in market share through repatriation and/or new services. Achievement of
this target will depend on other the success of other system-level initiatives to increase support
outside of acute care.
Chart 3 – Acute Bed Projections for Both Hospitals, 2015 - 2040
FY 2015 FY 2020 FY 2025 FY 2030 FY 2035 FY 2040
AGH 26 20 22 22 23 22
CPDMH 22 17 19 20 21 21
Recent LHIN reports indicate there is a significant need for additional CCC beds and inpatient
rehabilitation care – see Chart 4
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Future program growth opportunities, other than Obstetrics, lie outside of acute inpatient care and
include:
More Seniors Care
More Day Surgery, Outpatient Services, Home & Community Care
More Non-Acute Bed Care
(*) including Rehabilitation and Convalescent Care
0-18 yrs 19 - 44 yrs 45 - 64 yrs 65+ yrs
Inpatient Care
Outpatient Services
Home Care
Community Care
Acute Beds
Sub-Acute beds (*)
CCC beds Long Term Care Beds
Growth Opportunities
Program Growth Opportunities
Program Growth Opportunities
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5. Stakeholder Feedback
tng consultants conducted a comprehensive stakeholder consultation process during January – February
2017 that included the following components:
Over 50 telephone and face-to-face interviews with board members, senior management and
key external partners
11 focus groups for senior management teams, managers at both sites, frontline staff (3 focus
groups at each site), hospital foundations & auxiliaries
Online survey – 118 responses to CPDMH survey and 161 responses to AGH survey
Community forums (Jan. 16, 17)
5.1 Strengths
Stakeholders identified the following as strengths of both organizations:
Reputation, ability of Senior Executives
Dedicated staff at both hospitals
Positive patient culture at both hospitals
Both hospitals are respected stewards
“Alliance” is becoming part of common language
Alliance has been well received by external partners
5.2 Challenges and Strategic Opportunities
There was consistent feedback from all stakeholder groups in these areas:
Challenges:
Different hospital cultures
Two communities with some insular thinking
Separate IT systems
Aging population of the County
Low public profile of the Alliance
Lack of financial support from government
Government restrictions on recruitment of family physicians
Lack of public awareness of hospital pressures
Rural communities in the shadow of large Ottawa hospitals
External and Internal communications
Two separate strategic plans
Future of aging CPDMH facility
Lack of clinical integration
Wanting to be all things to all people
Strategic Opportunities:
A new vision for hospitals/health care
Position the hospitals as leaders in health care
Linking healthcare with local economic development strategy
Better collaboration and use of resources with possible savings
Better communication with stakeholders
Increased partnerships
Create a future governance structure
Better integration of physicians
Increased shared training of staff
Redeveloped facilities at CPDMH
Continue to build campus of care model at AGH – include homecare as part of an integrated local system
Program specialization for each hospital
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When asked about specific opportunities for program and/or service collaboration between the
hospitals there was a high degree of alignment between AGH and CPDMH stakeholders. Both groups
identified all of the existing programs and services as well as CT scan, Home care, Internal Medicine,
Mental Health, Palliative Care, Dialysis, Chemotherapy and community education. Increased services for
seniors was also a consistent theme. Of note, CPDMH stakeholders also identified governance as an
opportunity that the two hospitals can collaborate on.
More detailed on the responses from each of the stakeholder groups can be found in the Appendix B.
6. Collective Vision for the Alliance
Taking into account the environmental scan information, the stakeholder feedback and the results of
their own deliberations, the Boards of AGH and CPDMH determined that the power and potential of the
Mississippi River Health Alliance represents the best way forward, recognizing that in addition to its
contribution to the collective whole, each partner brings individiual strengths to the Alliance.
From that point forward, there was a commitment to develop a collective vision and strategic directions
that reflect both shared and individual objectives and their commitment to quality and safety in
everything they do.
Alliance Vision: “Working Together for The Very Best Care” Together, the Mississippi River Health Alliance partners will lead the development of an integrated health system that is:
Responsive to Community Need – provides high quality and safe services that are coordinated,close to home and easy to access
Clinically Excellent – ensures services are delivered using evidence-based practice standards and methods
Innovative – looks beyond our own walls, thinks creatively and moves beyond the status quo
Accountable –ensures that physical, human and financial resources are used efficiently and effectively to provide appropriate services in the right place at the right time
Collaborative – fosters strong partnerships with service providers within Lanark County, throughout the Champlain LHIN and across Ontario
To bring our vision to life, the Alliance will work with closely with our partners and communities to:
Expand the definition of what is local in terms of our shared catchment area
Provide appropriate care closer to home
Support the provision of a broad range of health services across the continuum of care
Explore and welcome partnerships that advance the shared vision.
Both Organizations Contribution to the Alliance Vision: Together, Carleton Place District Memorial Hospital and Almonte General Hospital support the Alliance vision by providing:
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Caring and committed staff, physicians and volunteers Personalized care Proven Receptivity to innovation and collaboration integration leadership
AGH’s Unique Contribution to the Alliance Vision:
Campus of care model which includes long term care (Fairview Manor), emergency services (Lanark County Paramedic Services) and primary care (Ottawa Valley FHT)
Clinical program strengths including: o Obstetrics o Long Term Care o Complex Continuing Care
CPDMH’s Unique Contribution to the Alliance Vision:
Ministry approval to build a new emergency department
Potential for further site redevelopment Clinical program strengths including:
o Same day surgeries o Outpatient clinics o Telemedicine
7. Key Strategic Directions for the Alliance
A modified balanced scorecard framework was used to define both shared and separate strategic
directions and strategic enablers:
Strategic Directions
The following four strategic directions are shared by both organizations, in support of the shared
Alliance Vision:
1. Provide outstanding care close to home
2. Work with health system partners to strengthen communication and collaboration
(between us) to make accessing care and support as easy as possible for patients,
residents and families
3. Align and activate our people to bring our vision and priorities to life
4. Maximize the potential of the Alliance
For each strategic direction, some key objectives were developed as well as what success will look like in
terms of outcomes:
KEY STRATEGIC DIRECTIONS: How We Will Define Success?
1. Provide outstanding care close to home by:
Developing a shared clinical services plan that describes the role of each organization in supporting appropriate
Explicit LHIN support for the shared clinical services plan
Reduced duplication between sites based on resource optimization
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KEY STRATEGIC DIRECTIONS: How We Will Define Success?
care closer to home, leveraging the unique contributions of each organization, minimizomg duplication, and optimizing allocation of resources between the sites
Supporting patients, residents and families to be more involved in their own care as part of the health care team
Increasing the breadth and depth of services offered by the Alliance partners for patients, residents and families based on larger critical mass of the shared catchment area
Utilizing evidence and best-practice information to ensure quality
Expanding on-site rural healthcare education opportunities for clinical and administrative students
Increased market share for select programs
Improved clinical performance in ALC rates, readmissions
Improved patient, resident and family satisfaction scores
Greater participation by Patient Family Advisory Councils in decision-making
Increased breadth of services
New health professionals recruited based on combined critical mass of MRHA catchment area
Joint credentialing of physicians at both sites
Performace in the top 50% of publicly reported quality indicators
Achievement of Quality Improvement Plan targets
Increased medical student days
Increased student placements
2. Work with health system partners to strengthen communication and collaboration (between us) to make accessing care and support as easy as possible for patients, residents and families by:
. Actively participating as a founding
member of the North Lanark Health Link for complex patients
Partnering with the Champlain LHIN and others to align hospital, community and home-based services
Working with partners to identify and support the best location for care
Helping patients navigate the complexities of the health system
More coordinated care plans for complex, high-needs patients
Reduced readmissions and avoidable Emergency Department visits
LHIN approval of a North Lanark plan for community and home-based services
3. Align and empower our people to bring our vision and priorities to life by:
Building a sustainable culture that fosters teamwork, promotes communication, encourages innovation, expects accountability, and celebrates the contributions of individuals and teams to the success of the organization and the Alliance
Improved staff, physicians and volunteer engagement scores
Positive trends in all Human Resource indicators including sick time, turnover and grievances
Shorter recruitment cycle for vacant staff,
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KEY STRATEGIC DIRECTIONS: How We Will Define Success?
Developing the capacity of formal and informal leaders to lead
Encouraging personal and professional development at all levels in both organizations
Identifying and preparing future leaders
Creating an engaging and fulfilling work environment for staff, physicians and volunteers
physician and volunteer positions
Improved patient, resident and family satisfaction scores
4. Maximize the potential of the Alliance by:
Leveraging opportunities to improve service and/or reduce cost through shared resources
Adopting best practices in the governance relationship between AGH and CPDMH
Branding and heightening community and partner awareness of the Alliance
Creating an Alliance outreach strategy to engage partners in North Lanark, Lanark County and the Champlain LHIN in the improvement of care for the communities served by AGH and CPDMH
Increased breadth and depth of services
Reduced cost per unit of service (weighted case, weighted patient day, ED visit, etc)
Increased name recognition for the Alliance
Increased formal and informal partnerships
Strategic Enablers
Strategic enablers are fundamental requirements that must be in place to achieve the Alliance’s goals in any or all of the key strategic directions. AGH and CPDMH have identified three key strategic enablers:
1. Harness technology to support improved coordination and information flow amongst organizations
2. Strengthen our financial position to enable investments that improve our system of care
3. Improve our communication with internal and external stakeholders
STRATEGIC ENABLERS:
How We Will Define Success?
Harness technology to support improved coordination and information flow amongst organizations by:
Standardizing processes across the organizations to create efficiencies in the use of human, physical and/or financial resources
Optimizing telemedicine as a vehicle for access to specialist consultation and
Improved staff and physician engagement scores
Increased standardization
Increased Telemedicine visits
Greater electronic communication and information sharing between providers and with patients
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STRATEGIC ENABLERS:
How We Will Define Success?
education
Considering the use of technology tools such as remote monitoring in the delivery of outpatient and home based services
Determining the most appropriate way to share information between providers and with patients for the purpose of facilitating appropriate care and efficient operations
Smooth patient transitions inside the hospital and across the health system
Easy access for physicians and staff to Electronic Medical Record and other information in each hospital’s information system for patient care and operations regardless of location
Strengthen our financial position to enable investments that improve our system of care by:
Safeguarding long term financial sustainability based on a sustainable program mix
Acting nimbly on new LHIN funding opportunities
Collaborating with the Foundations to support the priorities of both Hospitals
Cultivating community (donor) support
Exploring public-private partnerships
Balanced annual operating budgets
Key financial ratios (to be determined) within target
Hospital foundations fully supporting annual equipment and major capital requirements
Twice yearly discussion at Board level regarding public-private partnerships
Improve communication with internal and external stakeholders by:
Building a framework for internal communications that addresses the unique challenges of reaching a diverse 24-7 workforce
Creating a forum for conversation with community & partners and updating them on the Alliance’s progress and accomplishments
Comprehensive communications strategy stratified by target groups
Positive feedback from community and partners
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8. Organization – Specific Strategies
8.1 For Carleton Place & District Memorial Hospital
KEY STRATEGIC DIRECTIONS How We Will Define Success?
Advancing Redevelopment of CPDMH by:
Completing the construction of the new emergency department by 2022
Developing and implementing a plan for use of the space vacated by the emergency department
Creating a physical plant strategy plan to consistent with the shared clinical services plan and associated support service needs
Completion of the new emergency department
Completion of the plan for the old emergency department space
Agreement in principle by the LHIN and Ministry for the site redevelopment plan
Stage 1 approval for the next phase of redevelopment
OTHER STAKEHOLDER PRIORITIES
Utlizing the Health Hub concept to create a plan for utilization of the balance of the hospital site
8.2 For Almonte General Hospital
KEY STRATEGIC DIRECTIONS How We Will Define Success?
Advancing Regional Programs of AGH by:
Increasing birthing and newborn volumes within the Regional Obstetrics Program
Ensuring access to the clinical services required to support the Regional Obstetrics Program and a focus on women’s health including Gynecology, Anesthesia, Inpatient, Emergency and Diagnostic Imaging
Sustaining the Regional Complex Continuing Care Program and Fairview Manor in their provision of services to complex and elderly patients and residents from North Lanark and Eastern Ontario and pursuing expansion as dictated by the needs of the communities served
Advocating for appropriate access to inpatient rehabilitation services for North Lanark residents, creating capacity to provide those services within the Alliance
Increased patient volume in Obstetrics and Gynaecology, Inpatient and Emergency Department services
Increased market share for Obstetrics and Gynaecology
Acquisition of a CT Scanner
Complex continuing care and rehabilitation service levels (inpatient and outpatient) for the AGH regional catchment area equivalent to the rest of the Champlain LHIN
Sustained Fairview Manor resident and family satisfaction scores at 100% “would recommend” while seeking solutions to reducing wait times for access to beds
Acquisition of bed licenses and approval to expand the physicial capacity of Fairview Manor
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KEY STRATEGIC DIRECTIONS How We Will Define Success?
hospitalsn and securing associated funding
Seeking opportunities to expand capacity at Fairview Manor to address wait time of 5+ years
OTHER STAKEHOLDER OPPORTUNITIES
Continue to build partnerships to fully utilize the campus
9. Next Steps
Following approval of this new strategic plan by both hospital boards, the following short-term
implementation steps will move the organizations forward:
Developing a communications strategy to support roll-out of the new plan to internal and external audiences
Creating detailed implementation plans , timeframes & monitoring framework to support the shared and separate strategic directions
Determining the parameters, methodology , data requirements and evaluation criteria for the shared clinical services plan
Working with the Champlain LHIN to identify 'care closer to home' opportunities as part of regional clinical plans (e.g. Sub-Acute) and sub-region strategies (e.g. Home care)
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APPENDIX A1 – SWOT Analysis for CPDMH (FROM: April 8th Board Retreat)
Strengths: • our people - staff, physicians, senior team • approval of new future emergency department • quality of services including same day surgeries, outpatient clinics, telemedicine • our partnership with AGH • community support
Weaknesses: • hospital building – appearance, space,
physical plant • sustainability of a 22-bed acute hospital –
need to revisit types of bed • challenges of caring for patients in an aging
facility • community needs exceed funded capacity • hybrid EMR – paper & electronic and cost of
new IT/IS system • long term financial position • capacity of Foundation to mount a major
capital campaign • lack of influence at Queens Park
Threats: • maintaining the status quo and not
making a decision about redevelopment
• no additional operating funds for new Emerg
• proximity to Ottawa - volume of cases leaving the community
• growing and aging community • health professional recruitment
challenges • lack of comprehensive clinical plan for
Champlain LHIN • uncertainty about future role of LHIN
sub-regions • evolving funding formula for small
hospitals • provincial deficit and health spending
as % of provincial budget
Opportunities: REDEVELOPMENT
• Phased redevelopment strategy on current hospital site NEW/EXPANDED SERVICES
• Proactively defining WHO we are and WHAT we do • Determining community needs and translating that into new services • Providing or ensuring the provision of more non-acute services such as Homecare, Mental
Health • Building on program strengths such as outpatient clinics and telemedicine
INTEGRATION & PARTNERSHIP
• Becoming the Alliance • Evolving the Alliance to a single organization/system where staff at both sites work as a team • Re-branding the hospital and re-envisioning what a small hospital is • Leverage the Alliance in terms of single voice with the LHIN
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APPENDIX A2 - SWOT Analysis for AGH (FROM: April 9th Board Retreat)
Strengths: • our people - staff, physicians, senior team • campus of care model - continuum of care • quality of services including Obstetrics, Long Term Care, Complex Continuing Care, Lanark EMS • well-developed governance model • our partnership with CPDMH • community support
Weaknesses: • small size in terms of critical mass, HR
capacity, less voice compared to bigger centres – leads to greater vulnerability
• unrealistic expectations of community and partners
• community needs exceed funded capacity
• IT infrastructure (pending Cerner implementation)
• communication strategies (including lack of social media presence)
• Fairview Manor wait lists • long term financial position
Threats: • proximity to Ottawa - volume of cases leaving
the community • trying to serve all ages - youth vs seniors • increasing demand from a growing and aging
community • proximity of 2 Emerg Depts • health professional recruitment challenges,
including Ministry restrictions on physician recruitment
• lack of comprehensive clinical plan for Champlain LHIN
• uncertainty about future role of LHIN sub-regions
• evolving funding formula for small hospitals • provincial deficit and health spending as % of
provincial budget
Opportunities: NEW/EXPANDED SERVICES
• Leaders in seniors care • Building on Obstetrics program to create stronger focus on Women’s Health • Hub for Paediatric care • Increase capacity for same day surgeries • Add Homecare to service offerings • More long term care including expansion of Fairview Manor • Mental health services • Health promotion • Palliative care • System navigation for patients that includes patient advocacy • Build our capacity for research • Shared clinical services plan with our partner
INTEGRATION & PARTNERSHIP
• Leader in rural health systems development • Becoming the Alliance • Bigger Alliance with more partners & flexible partnership options
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• Positioning for LHIN sub-region • Explore integrated funding strategies including Rural Health Hub model • Strengthen relationship with PSFDH and other hospitals • Explore further collaborative opportunities with the FHT • Leverage the Alliance in terms of single voice with the LHIN • Build on work-in-progress IT solution
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APPENDIX B – DETAILED STAKEHOLDER FEEDBACK
tng consultants conducted a comprehensive stakeholder consultation process during January – February
2017 that included the following components:
Over 50 telephone and face-to-face interviews with board members, senior management and
key external partners
11 focus groups for senior management teams, managers at both sites, frontline staff (3 focus
groups at each site), hospital foundations & auxiliaries
Online survey – 118 responses to CPDMH survey and 161 responses to AGH survey
Community forums (Jan. 16, 17)
5.1 Stakeholder Interview Highlights
Stakeholders identified the following as strengths of both organizations:
Reputation, ability of Senior Executives
Dedicated staff at both hospitals
Positive patient culture at both hospitals
Both hospitals are respected stewards
“Alliance” is becoming part of common language
Alliance has been well received by external partners
In terms of challenges and opportunities, stakeholders identified the following:
Biggest Challenges:
Different hospital cultures
Two communities with some insular thinking
Limited and different technology (IT) systems
Ability to attract human resources
Funding support from community
Aging population of the County
Current level of staff salaries
Lack of clinical integration
Low public profile of the Alliance
Lack of financial support from government
Being in the shadow of large Ottawa hospital
Donor confusion over changes
Two foundations with a limited area
Government restrictions on recruitment of family physicians
Two separate strategic plans
Wanting to be all things to all people
Strategic Opportunities:
A new vision for hospital/health care in area
Position the hospitals as leaders in health care
Better use of resources with possible savings
Determine program specialization for both hospitals
Better communications with stakeholders
Increased partnerships
Create a future governance structure
Better integration of physicians
Increased shared training of staff
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New or Expanded Program/Services:
More coordinated development of clinics
Increase diagnostic imaging capacity
Increase in services to seniors
Increase mental health services
Palliative care services including a hospice
Focus on needs of all Lanark County residents and work with partners to plan future services
Increased involvement in regional service delivery
5.2 Focus Group Highlights
Key themes from focus group participants are described below:
Biggest Challenges:
Finances – government funding and impact on staffing
Staffing limitations - recruitment
Getting two hospitals to work together given different cultures– sharing a senior management team is a good start
Separate IT systems
Future of CPDMH facility in terms of infrastructure requirements
Rural nature of communities we serve
Aging population
External and Internal communications
Lack of public awareness of hospital pressures
Strategic Opportunities:
Staffing - recruitment/retention incl. education opportunities
Customer service (Patients First) culture – needs of patients/families vs needs of professionals
More volunteer coordinators
Better collaboration between hospitals
More shared back-office supports
Different services offered at each site
Better awareness of what current services are available
Redeveloped facilities at CPDMH – health village concept still makes sense
Continue to build campus of care model at AGH – include home care as part of an integrated local system
Better internal and external communications
Community education – help people understand that health care system is changing
Linking health care with local economic development strategy –hospitals are largest employers
New or Expanded Program/Services:
a) Hospital- based Care o CT scanner o Growing Obstetrics (expanded catchment area) o Women’s Health (building on successful OB program) o Mental Health and Psychiatry o In-house lab
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o Increase GEM nurses o Better use of operating rooms o Greater variety of clinic, outpatient services o New medical services that are not dependent on specialized equipment (e.g. psychiatry)
b) Health Care in our Communities
o Home care o Dialysis o Chemo clinic o Hospice care o Cardiac ultrasound o Walk-in clinic for non-urgent care o Geriatric care – increased services for seniors o Better partnerships with community providers
5.3 Online Survey Results
There was a strong response to the online survey. Key questions focused on
Review of current mission, vision and values statements
Current core services and gaps in service
Challenges and opportunities
Future vision and key strategic priorities for next 3-5 years
In support of further collaboration between the two hospitals, respondents were also asked:
o “What do you think the hospitals can achieve together that they can’t achieve on their own?”
and
o “What specific hospital programs, services or opportunities do you feel the two hospitals can
collaborate on?”
Responses are listed below:
AGH Responses CPDMH Responses
What the hospitals can achieve together that they can’t achieve on their own
Increased services
Shared services
Shared resources
Efficiencies & less duplication
Financial savings
Specialization between hospitals
Increased purchasing power
Share expertise & knowledge
Better policies & procedures
Coordination of services between hospitals
Shared knowledge & resources
A stronger voice
Greater efficiency & reduce duplication
Reducing administrative duplication
Increased purchasing power
A larger organization
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Sharing facilities
Attracting specialists
Specific hospital programs, services or opportunities the two hospitals can collaborate on
Administrative functions
Ambulatory care
Clinics
Cardiac Care
Community awareness/education
Complex continuing care
Day hospital
Diagnostic services
Dialysis
Emergency wait times
General surgery
Home care
Education & training
Financial efficiencies
Internal Medicine
Laboratory
Long term care
Mental health
Obstetrics
Operating rooms
Outpatient services
Palliative Care
Policies & procedures
Physiotherapy
Purchasing power
Shared resources & knowledge
Seniors care
Specialized services & staff
Telemedicine
Administrative roles and functions
Ambulatory care
Clinics
Coordinated services
Share medical files
Emergency services
Education services
Diagnostic services
Financial efficiencies
Governance
Home services
Inpatient services
Internal Medicine
Laboratory
Long term care
Mental health services
Obstetrics
Palliative care
Physiotherapy
Prenatal & birthing
Purchasing power
Services for an aging population
Shared equipment
Shared staff
Specialty programs & specialists
Surgical services
Technology
Telemedicine
Upgraded facilities